The Role of Environmental Factors in the Aetiology of Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature

Emotional Changes during Imagery Rescripting of Aversive Social Memories in Social Anxiety Disorder: A Randomized Controlled Trial

INTRODUCTION

Imagery rescripting (ImRs) is a psychotherapeutic intervention targeting aversive memories. During the three-phase intervention, patients reexperience their aversive memory (phase 1), observe the scene from their adult perspective, and intervene to help their former selves (phase 2), and reexperience it again with the positive changes (phase 3). Previous studies have rarely investigated emotional and regulatory processes taking place during the intervention.

OBJECTIVE

This randomized controlled trial investigated self-reported affective and physiological responses during ImRs.

METHODS

Seventy-seven patients with social anxiety disorder (SAD) were randomly assigned to a single session of ImRs or a control intervention (recall and discussion of the memory) targeting an aversive social memory. Heart rate (HR) and heart rate variability (HRV) were assessed during and post hoc ratings of positive and negative feelings after baseline and the intervention phases.

RESULTS

Relative to the control intervention, ImRs resulted in an initial increase in negative feelings from baseline to phase 1 and a following larger (phase 1 to phase 2) and more stable (phase 2 to phase 3) decrease in negative feelings/increase in positive feelings. On the physiological level, during ImRs compared to the control intervention, mean HR was significantly higher during phase 1 and HRV during phase 3, each compared to baseline.

CONCLUSIONS

These results provide further information about the specific sequence of emotional responses on different response levels during ImRs, being consistent with known theories of emotional processing and supposed mechanisms of ImRs.

The role of developmental caregiving programming in modulating our affiliation tendency and the vulnerability to social anxiety and eating disorders

Attachment is the evolutionarily-established process through which humans create bonds with others to receive care from them. The phenomenon is as essential to our physical survival as it is to our psychological development. An increasing number of studies demonstrates that in sensitive periods during the early years of life, our brain circuitry is programmed in the interactions with our caregivers, with the imprinting of information over multiple attachment dimensions. Adopting a basic brain-computer analogy, we can think of this knowledge as the psycho-social firmware of our mind. According to a recently proposed extension of the classical three-dimensional view, one attachment dimension - somaticity - concerns the caregiver's task of reflecting and confirming the child's (internal) states - such as sensations, emotions, and representations - to support the child's ability to identify and define those entities autonomously. Relying on multidisciplinary evidence - from neuroscientific, developmental, evolutionary, and clinical sources - we suggest that somaticity (H1) has the adaptive function to modulate our tendency to comply and affiliate with a reference group but also (H2) increases the vulnerability to developing Social Anxiety (SA) and Eating Disorders (EDs). We evaluate H1-H2, (1) indicating the evolutionary role of somaticity in modulating our affiliation tendency to optimize the ancestral threat-opportunity balance coming from infectious diseases and (2) showing the deep connection between SA-EDs and the features most closely related to somaticity - interoception and parenting style. Finally, we discuss three relevant implications of H1-H2: (A) Bringing into research focus the adaptive role of our firmware knowledge system versus the hardware (neural substrate) and software (higher cognition) ones. (B) Complementing the well-grounded Objectification and Allocentric Lock Theories, allowing us to integrate multiple levels of explanation on the etiology of psychopathology. (C) Suggesting the design of new psychological treatments. While not aiming to prove H1-H2, our analysis supports them and encourages their direct testing.

Factors affecting social phobia among Chinese college students in the context of COVID-19 pandemic: a cross-sectional study

Social phobia (SP) refers to excessive anxiety about social interactions. College students, with their exposure to academic, familial, and job-related pressures, are an ideal population for early screening and intervention of social phobia. Additionally, COVID-19 prevention measures including keeping social distance may further impact social phobia. This study aims to investigate the influencing factors of social phobia among Chinese college students and to tentatively explore the impact of COVID-19 prevention measures on social phobia. Respondents were recruited through Chinese Internet social platforms for an online survey. College students' social phobia scores in pre- and early-COVID-19 periods were measured using Peters' short form of the Social Interaction Anxiety Scale and Social Phobia Scale (SIAS-6/SPS-6). Demographic information, family information, social relations, self-evaluation, and subjective feelings regarding the impact of COVID-19 preventive measures on social phobia were collected. A multivariable logistic regression model was used to analyze the influencing factors. A total of 1859 valid questionnaires were collected, revealing that the social phobia scores increased from 12.3 ± 11.9 to 13.4 ± 11.9 between pre- and early-COVID-19 periods, with an increase of 1.0 ± 6.4 (p < 0.001). Low GPA rank, mobile phone dependence, distant family relationships, indulgent parents, childhood adversity, and childhood bullying were risk factors for social phobia among Chinese college students. Female gender, being a senior university student or postgraduate, satisfaction with physical appearance, self-reported good mental health and high level of interpersonal trust were protective factors for social phobia. Although most respondents believed that COVID-19 prevention measures (e.g., mask wearing and social distancing rules) reduced their social phobia, these measures were not significantly associated with social phobia levels in the multivariable analyses. In conclusion, Chinese college students' social phobia was widely influenced by diverse factors and warrants increased attention, with early intervention aimed at high-risk individuals being crucial for their mental health. Additional research is necessary to understand the impact of COVID-19 preventive measures on social phobia among college students.

Associations between resting-state neural connectivity and positive affect in social anxiety disorder

INTRODUCTION

Social anxiety disorder (SAD) has been characterized by deficits in social motivation and lack of reactivity to pleasurable stimuli (i.e., positive affect; [PA]). Recent neuroimaging work has shifted toward examining positively valenced motivational systems in SAD focused on reward responses. However, little is known about the associations of reward connectivity and PA in individuals with SAD. As such, the purpose of the current study was to determine whether connectivity among key units of reward neurocircuitry meaningfully relate to PA and whether these key units are more heterogeneous in SAD as compared to controls.

METHODS

Thirty-one participants who met diagnostic criteria for SAD and 33 control participants were included (Mage = 24.8, SD = 6.9; 55% cisgender man). Seed-based timeseries correlations were conducted in NiTime to extract region of interest (ROI) coupling correlation strength values. ANOVAs were carried out to assess whether individuals with SAD differed in ROI-to-ROI connectivity strength as compared to controls. Correlations and variance analyses were also conducted to examine the relationship between ROI-to-ROI connectivity strength and PA, as well as heterogeneity in connectivity strength and PA expression.

RESULTS

Weaker connectivity between the left and right orbital frontal cortex was observed when comparing the SAD to the control group. Within the SAD group, PA was associated with several reward-related ROI couplings; however, these links were not observed among controls. Results further demonstrated that individuals with SAD had significantly more variability in reward connectivity strength as compared to controls.

CONCLUSION

Overall, these results provide emergent evidence for the association between reward regions and PA in individuals with SAD. Additionally, these findings show that individuals with SAD demonstrate greater heterogeneity in reward connectivity.

The relationship between child maltreatment and social anxiety: A meta-analysis

BACKGROUND

Globally, child maltreatment has become a serious problem, affecting individuals' physical and mental health. This meta-analysis aimed to explore the association between child maltreatment and social anxiety.

METHODS

MEDLINE, PsycINFO, EMBASE, Scopus, and Web of Science were searched for articles published by October 2021. Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate the quality of studies. Maltreatment type, sample setting, age, country and measurement instruments were analyzed as moderators.

RESULTS

Twenty-nine studies met the inclusion criteria. Child maltreatment was positively correlated with social anxiety (r = 0.201, 95 % CI [0.171, 0.230]). The moderating effect of maltreatment subtypes was significant whether divided into three types (Q_b = 12.152, p = .002), or five types (Q_b = 11.574, p = .021). Specifically, emotional maltreatment (r = 0.251, 95 % CI [0.201, 0.298]) had a stronger relationship with social anxiety than physical (r = 0.138, 95 % CI [0.085, 0.191]; Q_b = 9.312, p = .002) and sexual maltreatment (r = 0.153, 95 % CI [0.108, 0.197]; Q_b = 9.197, p = .002). However, there was no significant difference in the effect size between physical and sexual maltreatment (Q_b = 0.096, p = .757). Other variables (age, sample setting and country) were not significant moderators.

LIMITATIONS

Only twenty-nine studies were included, and there was high heterogeneity among the studies, the interpretation of the results should be cautious.

CONCLUSIONS

This meta-analysis confirmed the relationship between child maltreatment and social anxiety, especially highlight the harmfulness of emotional maltreatment.

An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization

BACKGROUND

Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals.

METHOD

Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style.

RESULTS

Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother.

CONCLUSION

Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.

Impact of observational and direct learning on fear conditioning generalization in humans

Humans gain knowledge about threats not only from their own experiences but also from observing others' behavior. A neutral stimulus is associated with a threat stimulus for several times and the neutral stimulus will evoke fear responses, which is known as fear conditioning. When encountering a new event that is similar to one previously associated with a threat, one may feel afraid and produce fear responses. This is called fear generalization. Previous studies have mostly focused on fear conditioning and generalization based on direct learning, but few have explored how observational fear learning affects fear conditioning and generalization. To the best of our knowledge, no previous study has focused on the neural correlations of fear conditioning and generalization based on observational learning. In the present study, 58 participants performed a differential conditioning paradigm in which they learned the associations between neutral cues (i.e., geometric figures) and threat stimuli (i.e., electric shock). The learning occurred on their own (i.e., direct learning) and by observing other participant's responses (i.e., observational learning); the study used a within-subjects design. After each learning condition, a fear generalization paradigm was conducted by each participant independently while their behavioral responses (i.e., expectation of a shock) and electroencephalography (EEG) recordings or responses were recorded. The shock expectancy ratings showed that observational learning, compared to direct learning, reduced the differentiation between the conditioned threatening stimuli and safety stimuli and the increased shock expectancy to the generalization stimuli. The EEG indicated that in fear learning, threatening conditioned stimuli in observational and direct learning increased early discrimination (P1) and late motivated attention (late positive potential [LPP]), compared with safety conditioned stimuli. In fear generalization, early discrimination, late motivated attention, and orienting attention (alpha-event-related desynchronization [alpha-ERD]) to generalization stimuli were reduced in the observational learning condition. These findings suggest that compared to direct learning, observational learning reduces differential fear learning and increases the generalization of fear, and this might be associated with reduced discrimination and attentional function related to generalization stimuli.

Memory representation of aversive social experiences in Social Anxiety Disorder

Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.

Relationship between Social Media Use and Social Anxiety in College Students: Mediation Effect of Communication Capacity

An increasing number of college students are experiencing social anxiety in an era of prevalent social networking. College students' social anxiety may be related to their social media use. However, this relationship has not been confirmed. This study aimed to investigate the relationships between different types of social media use and social anxiety among college students, and the mediation effects of communication capacity in this context. A large sample of 1740 students from seven colleges in China was analyzed. Bivariate correlation and structural equations analysis showed that passive social media use was positively correlated with social anxiety. Active social media use was negatively correlated with social anxiety. Communication capacity partially mediated the relationship between social media use (passive/active) and social anxiety. Active social media use may reduce social anxiety by positively mediating communication capacity, while improved communication capacity may reduce the contribution of passive use to social anxiety. The differences in the effects of different social media use on social anxiety deserve the attention of educators. Developing communication capacity education around college students may help reduce their social anxiety.

Developing an Anxiety Screening Tool for Children in South Africa: Protocol for a Mixed Methods Study

BACKGROUND

Early childhood experiences such as trauma, exposure to violence, and poverty can significantly contribute to childhood anxiety, which is viewed as the most common mental health issue among children. In South Africa, there is no uniform tool to screen for anxiety during early childhood. This study aims to develop a tool to screen for anxiety in children aged 4 to 8 years, which could be utilized by preschool and foundation phase teachers to aid in the early identification of childhood anxiety.

OBJECTIVE

The overall objective of this study is to explore understanding and perceptions of childhood anxiety among teachers, parents, and experts and to develop a tool to screen for anxiety in children aged 4 to 8 years.

METHODS

This project will use a mixed method design that will consist of 4 stages. Stage 1 will consist of a scoping review. In Stage 2, data will be collected via semistructured interviews with 60 participants, including parents, teachers, and experts, and will be thematically analyzed. Stage 3 will consist of 20 experts and the researcher collaboratively formulating the proposed screening tool in the form of an e-Delphi component. Once the tool is refined, it will be piloted in Stage 4 with 20 teachers, and data will be analyzed with the Shapiro-Wilk test to test for normality. Additionally, factor analysis will be done to refine and restructure the tool as necessary.

RESULTS

This project was funded from April 2020 to December 2021. Data collection began in September 2022 and is projected to conclude in December 2022 for the qualitative component. The e-Delphi component is expected to be carried out from March to November 2023. Ethical approval was obtained from the Biomedical Research Ethics Committee in November 2021.

CONCLUSIONS

Anxiety in early childhood has been linked to various repercussions in adolescence and adulthood, such as school dropout, substance abuse, anxiety disorders, depression, and suicide ideation. Therefore, identifying the presence of anxiety earlier on and providing the necessary referral services could aid in reducing the negative consequences of unidentified and untreated anxiety in early childhood.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37364.

Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative

Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.

External Locus of Control but not Self-Esteem Predicts Increasing Social Anxiety Among Bullied Children

Background

Elevated social anxiety is more likely among bullied children than those who have not been bullied but it is not inevitable and may be influenced by cognitive factors. Lower self-esteem and more external locus of control are associated with bullying and social anxiety but the impact of these factors over time among bullied children is less clear.

Method

Children from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) reported bullying experiences at age 8 (n = 6,704) and were categorized according to level of bullying exposure. The impact of self-esteem and locus of control on social anxiety was assessed up to age 13 across the bullying exposure groups using multi-group latent growth curve analysis. Complete data was available for 3,333 participants.

Results

More external locus of control was associated with a steeper increase in social anxiety among severely bullied children [B = .249, p = .025]. Although self-esteem at age 8 was associated with existing social anxiety it did not predict later increases in social anxiety.

Conclusion

These results indicate that beliefs about lack of personal control among severely bullied children may contribute to increasing social anxiety over time. Exploring related cognitions may be helpful in this potentially vulnerable group.

Potential processes of change in MDMA-Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self-transcendence, and therapeutic relationships

OBJECTIVE

Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4-methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder.

DESIGN

This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes.

RESULTS

We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors.

CONCLUSION

We discuss how processes of change may extend beyond the MDMA dosing sessions themselves.

The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management

The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.

The hidden burden of social anxiety disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

BACKGROUND

Social anxiety disorder (SAD) is a chronic and disabling psychiatric disorder associated with low levels of help-seeking. To date, however, scarce research has examined the epidemiology of SAD in veterans. This study examined the prevalence, comorbidities and incremental burden of SAD in relation to suicidality and functioning in a representative sample of U.S. military veterans.

METHODS

A nationally representative sample of 3,157 U.S. veterans completed a web survey containing measures of SAD symptoms, trauma history, psychiatric history and functioning. Multivariable analyses were conducted to examine associations between SAD and psychiatric comorbidities, suicidality and functioning.

RESULTS

A total 9.5% (n = 272) of the sample screened positive for lifetime SAD. Veterans with SAD were more likely than those without SAD to be younger, female, single, racial/ethnic minorities and to have experienced childhood abuse. They also had substantially elevated rates of comorbid psychiatric disorders, particularly lifetime major depression (odds ratio [OR]=5.8) and posttraumatic stress disorder (OR=3.1), as well as current suicidal ideation (OR=3.3). Veterans with SAD scored lower on measures of functioning, particularly social, emotional and mental health functioning (d's=0.21-0.34).

LIMITATIONS

Data were collected cross-sectionally using self-report.

CONCLUSIONS

SAD in U.S. veterans is prevalent and associated with psychiatric comorbidities, functional impairment and a more than 3-fold greater risk for suicidal ideation . Given that SAD is associated with low treatment seeking and engagement, it may be undetected and undertreated relative to other psychiatric morbidities. These results underscore the importance of screening, monitoring and treating SAD in this population along with other prevalent mental disorders.

A Novel Application of the Schema Therapy Mode Model for Social Anxiety Disorder: A Naturalistic Case Study

Social Anxiety Disorder (SAD) is a condition defined by an excessive and persistent fear of negative evaluation in social or performance situations. Whilst Cognitive Behaviour Therapy (CBT) is the gold standard treatment, not all individuals with SAD respond to CBT. The Schema Therapy Mode Model is frequently applied to chronic and hard-to-treat conditions and therefore may be applicable for SAD individuals who are non-responders to CBT. This case study describes how the Mode Model was successfully used to treat a woman in her 20s who presented with excessive fears of negative evaluation and pervasive social avoidance. Experiential techniques, such as chair dialogues and imagery rescripting, resulted in cognitive modification of negative core beliefs, reduced experiential discomfort and increased engagement in social and relational activities. This case offers a preliminary indication that the Schema Therapy Mode Model may be an effective treatment for socially anxious individuals and that further theoretical and empirical study in this area is warranted.

Family Conflict Associated With Intrinsic Hippocampal-OFC Connectivity in Adolescent Depressive Disorder

BACKGROUND

Family environment and life events have long been suggested to be associated with adolescent depression. The hippocampus plays a crucial role in the neural mechanism of major depressive disorder (MDD) through memory during stressful events. However, few studies have explored the exact neural mechanisms underlying these associations. Thus, the current study aimed to explore alterations in hippocampal functional connectivity (FC) in adolescent MDD based on resting-state functional magnetic resonance imaging and further investigate the relationship between hippocampal FC, environmental factors, and clinical symptom severity.

METHODS

Hippocampal FC was calculated using the seed-based approach with the bilateral hippocampus as the seed for 111 adolescents with and without MDD; comparisons were made between participants with MDD and controls. We applied the Chinese version of the Family Environment Scale (FES-CV) and Adolescents Self-Rating Life Events Checklist (ASLEC) to evaluate family environment and life stress. Their relationship with hippocampal FC alterations was also investigated.

RESULTS

We found that compared to controls, adolescents with MDD showed decreased connectivity between the left hippocampus and bilateral orbital frontal cortex (OFC) and right inferior temporal gyrus. In addition, the hippocampal-OFC connectivity was negatively correlated with conflict scores of the FES-CV in the MDD group and mediated the association between family conflict and depressive and anxiety symptoms.

CONCLUSION

Our findings are novel in the field and demonstrate how family conflict contributes to MDD symptomatology through hippocampal-OFC connectivity; these findings may provide potential targets for personalized treatment strategies.

Higher Social Anxiety Severity Predicts Better Cognitive Empathy Performance in Women but Not Men

Findings regarding relationships between social anxiety and subtypes of empathy have been mixed, and one study suggested that this may be due to moderation by biological sex. The present study examined whether accounting for general anxiety and biological sex clarifies these relationships. Undergraduates (N = 701, 76% female) completed online self-report measures of cognitive and affective empathy, social and general anxiety severity, and a behavioral measure of cognitive empathy (Reading the Mind in the Eyes Task; MIE). Path analysis examined relationships among social and general anxiety severity and affective and cognitive empathy. Model modification indices showed a significant influence of sex on the path from social anxiety severity to MIE accuracy. When the model was re-estimated with this path freed, more socially anxious women, but not men, showed greater MIE accuracy. Across both sexes, general anxiety severity related negatively to self-reported and behavioral (MIE) cognitive empathy. Affective empathy did not relate to either type of anxiety. The use of path analysis to simultaneously account for overlapping variance among measures of anxiety and empathy helps clarify earlier mixed findings on relationships between social anxiety and empathy subtypes.

Social anxiety symptoms among youth with chronic health conditions: trajectories and related factors

Purpose: This study explored three-year trajectories of social anxiety symptoms among youth with chronic health conditions and investigated factors influencing those trajectories.Methods: Participants (N = 439) were recruited from eight pediatric rehabilitation centers. The Social Anxiety Scale for Children-Revised measured social anxiety across four time points. Latent Class Growth Analysis was used to study trajectories and logistic regression to identify related factors.Results: A three-class solution was supported: a "high anxiety and stable" group (17.1%), a "moderate anxiety and stable" group (44.4%), and a "low anxiety and stable" group (38.5%). Youth in the "moderate and stable" group were less likely to be male compared to the "low and stable" group. Youth in the "high and stable" group were more likely to have greater cognitive symptoms and less likely to have higher levels of social participation compared to the "low and stable" group. Youth in both the "high and stable" and "moderate and stable" groups were less likely to have high support from classmates or close friends compared to the "low and stable" group. Moreover, both the "high and stable" and "moderate and stable" groups were less likely to have positive family functioning.Conclusion: Youth with chronic conditions belonging to "high and stable" and "moderate and stable" social anxiety trajectories can be distinguished from those in a "low and stable" trajectory using personal, functional, and environmental level variables.Implications for RehabilitationYouth with chronic health conditions are at risk of developing and maintaining moderate to high levels of social anxiety symptoms as they move through adolescence.Compared to youth with "low and stable" social anxiety, those with "moderate and stable" social anxiety are less likely to be male, have high peer support or high family functioning.Compared to youth with "low and stable" social anxiety, those with "high and stable" social anxiety are more likely to have greater cognitive symptoms, and less likely to have high social participation, high peer support, or high family functioning.Rehabilitation and other professionals should not only consider factors that are functional in nature; they should also consider personal and environmental level factors when supporting youth with chronic health conditions who experience social anxiety symptoms.

Depression with or without comorbid social anxiety: Is attachment the culprit?

Major depressive disorder (MDD) frequently co-occurs with social anxiety disorder (SAD), and their comorbidity (MDD-SAD) increases clinical severity and functional impairment. Still, the specific psychological vulnerabilities of individuals with MDD-SAD are poorly understood. Individual attachment characteristics develop early in life through interactions with primary caregivers, and tend to persist throughout life. Early trauma can worsen attachment insecurity, increasing the risk for future anxiety and depression. The purpose of this study is to examine differences in individual attachment and history of trauma in depressed individuals with or without comorbid SAD and controls. One hundred sixty-two participants were categorized into three groups based on SCID-I interview: healthy controls (HC), individuals with current MDD without SAD (MDD), and individuals with current MDD comorbid with SAD (MDD-SAD). MDD-SAD group had significantly greater attachment anxiety and attachment avoidance compared to the MDD and HC groups. MDD-SAD group had greater clinician-rated depression severity and dysfunction compared to MDD group. In summary, the study further supports the clinical risks associated with MDD-SAD and suggests that insecure attachment might represent an associated vulnerability and a possible pathway which warrants further research and clinical attention.

The Leiden Family Lab study on Social Anxiety Disorder: A multiplex, multigenerational family study on neurocognitive endophenotypes

OBJECTIVES

Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition, with a heritable component. However, little is known about the characteristics that are associated with the genetic component of SAD, the so-called "endophenotypes". These endophenotypes could advance our insight in the genetic susceptibility to SAD, as they are on the pathway from genotype to phenotype. The Leiden Family Lab study on Social Anxiety Disorder (LFLSAD) is the first multiplex, multigenerational study aimed to identify neurocognitive endophenotypes of social anxiety.

METHODS

The LFLSAD is characterized by a multidisciplinary approach and encompasses a variety of measurements, including a clinical interview, functional and structural magnetic resonance imaging and an electroencephalography experiment. Participants are family members from 2 generations, from families genetically enriched for SAD.

RESULTS

The sample (n = 132 participants, from 9 families) was characterized by a high prevalence of SAD, in both generations (prevalence (sub)clinical SAD: 38.3%). Furthermore, (sub)clinical SAD was positively related to self-reported social anxiety, fear of negative evaluation, trait anxiety, behavioral inhibition, negative affect, and the level of depressive symptoms.

CONCLUSIONS

By the multidimensional character of the measurements and thorough characterization of the sample, the LFLSAD offers unique opportunities to investigate candidate neurocognitive endophenotypes of SAD.